LARYNGEAL PARALYSIS

DR. ARJUN DASS

PROF. & HEAD

DEPT OF ENT

GMCH-32

MUSCLES OF LARYNX Intrinsic

Abductors : Post. Cricoarytenoid Adductors : Lat. Cricoarytenoids

ThyroarytenoidsInterarytenoids

Tensor : CricothyroidVocalis

Extrinsic: Elevators: Stylopharyngeus, salpingopharyngeus,

palatopharyngeus, thyrohyoid Depressor:Sternohyoid, sternothyroid,Omohyoid

CLINICAL ANATOMY

Nerve supply Motor

Recurrent Laryngeal nerve External Laryngeal Nerve

Sensory Internal Laryngeal Nerve Rec. Laryngeal Nerve

LARYNGEAL PARALYSIS

Unilateral or Bilateral May involve

Recurrent Laryngeal Nerve Superior laryngeal nerve Both Rec. & Sup. Laryngeal Nerve

(Combined paralysis)

CAUSES OF RECURRENT LARYNGEAL NERVE PARALYSIS

IDIOPATHIC TRAUMA

ACCIDENTALSURGICAL

INFLAMMATORYCERVICAL LYMPHADENITISMEDIASTINAL LYMPHADENITISTUBERCULOSIS OF CERVICAL PLEURA

NEOPLASMBENIGN THYROID DISEASEMALIGNANT THYROID DISEASECARCINOMA ESOPHAGUSCARCINOMA APEX LUNGBRONCHOGENIC CARCINOMA

SYSTEMIC DISEASESDIABETES,DIPTHERIA, SYPHILIS, LEAD POISONING

MISCELLANEOUSANEURYSM OF SUBCLAVIAN ARTENLARGED LEFT AURICLE

VARIOUS POSITIONS OF VOCAL CORDS

RECURRENT LARYNGEAL NERVE PARALYSIS

UNILATERAL

NO SYMPTOMS CHANGE IN VOICE VOCAL CORD IN

MEDIAN OR PARAMEDIAN POSITION

BILATERAL

STRIDOR DYSPNOEA WORSE ON

EXERTION OR ACUTE INFECTION

VOCAL CORDS IN MEDIAN OR PARAMEDIAN POSITION

TREATMENTUNILATERAL

NO TREATMENT

SPEECH THERAPY

BILATERAL

ACUTE CASESTRACHEOSTOMY

CHRONIC CASESTRACHEOSTOMY

SPEAKING VALVELATERALISATION OF CORDS

BY ARYTENOIDECTOMY CORDECTOMYNERVE MUSCLE IMPLANT

COMPLETE PARALYSIS

UNILATERAL

HOARSENESS ASPIRATION OF LIQUDS COUGH INEFFECTIVE VOCAL CORD IN

CADAVERIC POSITION GLOTTIC INCOMPETENCE

COMPLETE PARALYSIS

BILATERAL APHONIA ASPIRATION INABILITY TO COUGH VOCAL CORDS IN

CADAVERIC POSITION BRONCHOPNEUMONIA

TREATMENTUNILATERAL

SPEECH THERAPY MEDIALISATION OF

CORDTEFLON PASTEMUSCLE/CARTILAGE IMPLANTARTHRODESIS OF CRICO ARYTENOID JT

BILATERAL

TRACHEOSTOMY EPIGLOTTOPEXY VOCAL CORD

PLICATION TOTAL

LARYNGECTOMY

SUPERIOR LARYNGEAL PALSY

CONGENITAL PALSY

PHONOSURGERYProcedure designed to improve the voice qualityVarious procedures are:

1.Excision of Benign or malignant mass2. Injection of cord with teflon or gelfoam3.Thyroplasty :-

Type 1 Medialization of cordsType 2 LateralizationType 3 ShorteningType 4 Lenghtening

THANKS